Ps-425 form nyship
WebNYSHIP Termination of Domestic Partnership (PS-425.4) State employee submits application to terminate domestic partner from NYSHIP plan. Download the Form NYSHIP … WebOct 1, 2024 · Form PS-425 Nyship Domestic Partner Enrollment Application - New York Preview Fill PDF Online Download PDF What Is Form PS-425? This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York.
Ps-425 form nyship
Did you know?
WebNew York State Health Insurance Program (NYSHIP) Health Insurance Enrollment: Pre-Tax Contribution Program (PTCP) Fact Sheet PS404 NYS Health Insurance Transaction Form; PS-404(G) - SEHP (GSEU) Health Insurance Transaction Form; NYS Opt-Out Attestation Form (PS-409) Statement of Disability for Dependents (PS-451) Weba NYSHIP HMO, contact the HMO directly. Important Dates for Your Benefit Choices If you want to make a change for 2024 December 30, 2024 Deadline for submitting a signed NYSHIP Health Insurance Transaction Form (PS-404) to your HBA if you want to change your health insurance option and/or Pre-Tax election for the 2024 plan year. Employees …
Webdownload the Dual Annuitant Sick Leave Credit Election Form (ps-405) Where to Submit These Forms: Email: [email protected] Fax: 518-457-1879 Mail: BSC Benefits Administration W. Averell Harriman State Office Campus 1220 Washington Avenue Building 5, Floor 4 Albany, NY 12226-1900 Next Section Deferring Your Coverage Deferring Your …
WebAlbany, NY 12239 for NYS & PE Employees PS-404 (1/2024) NYSHIP Program Information Resources . To enroll in benefits or to change your current benefits, you will most likely be required to submit proofs of eligibility for coverage or evidence of a qualifying event with the completed and signed NYSHIP . Health Insurance Transaction F orm. PS-404. WebSummary of NYSHIP Required Proofs: Spouse. Domestic Partner. Child. Other Child* Copy of Birth Certificate** Social Security Number*** Medicare Claim Number (if enrolled in …
Websubmit Form PS-425.4, Termination of Domestic Partnership. Your domestic partnership is considered to be in effect as of the earliest documented date that you and your Domestic …
WebTermination of Domestic Partnership for NYSHIP PS-425.4 (3/17) I, certify that: Name of Enrollee (Please Print) I, and Name of Enrollee (Please Print) Name of Domestic Partner (Please Print) ... year after the date this form is filed. I understand that my partner’s children named below, if any, that are covered under my NYSHIP enrollment will ... the roof anchor companyWebeligibility for as long as you wish to continue to cover your Domestic Partner as your dependent in NYSHIP. 1. Proof of Joint Responsibility for Basic Financial Obligations. You … tracksuit for toddlers gold and blackWebSee PS-425.1 for acceptable proofs. FOR CHILDREN UP TO AGE 26 AND DISABLED CHILDREN: A copy of the child’s birth certificate, hospital birth record, or adoption certificate naming you or your spouse as the child's parent FOR “OTHER” CHILDREN: A copy of the Statement of Dependence PS-457 form (available on www.VerifyOS.com) AND the roof and gutter doctorWebcomplete PS-409, Opt-out Attestation form. 11.B.2 New enrollees must make an election (PrePre-Tax Contribution Program (PTCP) Status -Tax or Post-Tax) for the PTCP. 11.C Decline NYSHIP Coverage Check box to decline coverage. Be sure to check the appropriate boxes for the coverage type declined. CHANGE IN COVERAGE OR VOLUNTARILY CANCEL … the roof and gutter peopleWebns truc tions for NY S Health Insurance Transac tion Form PS-404 ( 9/2024) NYSHIP Program Information Resources . To enroll in benefits or to change your current benefits, you will most likely be required to submit proofs of eligibility for coverage or evidence of a qualifying event with the completed and signed . Health Insurance Transaction F orm tracksuit for winter seasonWebNYSHIP Application for Enrolling Domestic Partners (PS-425) State employees apply for enrolling domestic partners in NYSHIP and affidavit of domestic partnership. Download … tracksuit from dude wheres my carWebTermination of Domestic Partnership for NYSHIP PS-425.4 (3/17) I, certify that: Name of Enrollee (Please Print) I, and Name of Enrollee (Please Print) Name of Domestic Partner … tracksuit from 90s